Provider Demographics
NPI:1932250073
Name:JACKMAN, JANICE PERPIGNANI (OD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:PERPIGNANI
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:LEE
Other - Last Name:PERPIGNANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2700 N MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6638
Mailing Address - Country:US
Mailing Address - Phone:714-543-2022
Mailing Address - Fax:714-760-4473
Practice Address - Street 1:2700 N MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6638
Practice Address - Country:US
Practice Address - Phone:714-543-2022
Practice Address - Fax:714-760-4473
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9791-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP9791FMedicare PIN
CASD0097910Medicare ID - Type Unspecified
CAU38990Medicare UPIN
CAWOP9791QMedicare PIN